Body Composition Among HIV-Seropositive and HIV-Seronegative Adult Patients with Pulmonary Tuberculosis in Uganda

doi:10.1016/j.annepidem.2009.11.001

Annals of Epidemiology

Volume 20, Issue 3, March 2010, Pages 210-216

https://doi.org/10.1016/j.annepidem.2009.11.001 Get rights and content

Purpose

We determined whether human immunodeficiency virus (HIV) infection affects body cell mass and fat mass wasting among adults with pulmonary tuberculosis (PTB).

Methods

We screened 967 Ugandan adults for PTB and HIV infection in a cross-sectional study. We compared anthropometric and bioelectric impedance analysis (BIA) body composition parameters among HIV-seropositive and HIV-seronegative men and women with or without PTB by using a non-parametric test.

Results

We found that poor nutritional status associated with TB differed among men and women. Anthropometric and BIA body composition did not differ between HIV-seropositive and HIV-seronegative patients regardless of gender. Average weight group difference in men consisted of body cell mass and fat mass in equal proportions of 43%. In women, average weight group difference consisted predominantly of fat mass of 73% and body cell mass of 13%. Compared to individuals without TB, patients with TB had lower body mass index, weight, body cell mass, and fat mass regardless of gender and HIV status.

Conclusions

Gender, but not HIV status, was associated with body composition changes in TB. TB appears to be the dominant factor driving the wasting process among co-infected patients.

Introduction

Body wasting is a prominent and cardinal feature of tuberculosis (TB) 1, 2 and is a marker of disease severity and outcome. In sub-Saharan Africa, a large proportion of patients with TB also have coinfection with human immunodeficiency virus (HIV) (3). Coinfection may worsen the wasting seen in either TB or HIV infection alone 4, 5. Wasting in TB is associated with reduced caloric intake due to anorexia or loss of appetite and increase in consumption of calories due to altered metabolism induced by inflammation and immune response 6, 7, 8.

Several studies 9, 10, 11, 12, 13, 14, 15 in sub-Saharan Africa have shown the impact of dual infection with HIV and TB on nutritional status by using anthropometric measurements. However, body composition measured by anthropometry including fat mass and fat-free mass (16) may be associated with observer bias. Furthermore, anthropometry may not predict body cell mass, the metabolically active component of the body that may be associated with adverse effects on survival. Therefore anthropometry provides only limited information about nutritional status in patients. Bioelectrical impedance analysis (BIA) offers a useful alternative to anthropometry because it measures multiple body compartments and provides a more detailed assessment of body composition. Several cross-sectional studies 10, 12, 14, 15, 17 have examined the impact of HIV infection on body composition of adults with TB disease but are limited because they lacked a comparison group free of TB disease or HIV infection to show the independent metabolic effects of TB disease and HIV infection. Some studies were limited by small sample sizes 10, 14, 15, whereas others (6) comprised only men in the study population.

The current cross-sectional study with a large sample size including both men and women was conducted in Kampala, Uganda, to determine whether HIV infection is associated with body cell mass and fat mass wasting among adults with TB disease. We hypothesized that HIV-seropositive patients with TB disease had marked depletion of body cell mass and fat mass stores when compared to HIV-seronegative patients with TB disease.

Section snippets

Material and Methods

We conducted a cross-sectional study to address the objective of the present study. The study population consisted of 445 index TB patients and 522 household contacts without evidence of TB aged 18 or more years selected from Kawempe Division in Kampala, Uganda. Index patients presenting with sputum-positive pulmonary TB (PTB) to the National Tuberculosis and Leprosy Program at the Tuberculosis Clinic of Upper Mulago Hospital complex and their household contacts were recruited to the study

Results

Of the 944 participants who were included in the analysis, 93 men and 103 women were HIV seropositive with TB disease; 145 men and 104 women were HIV seronegative with TB disease; 22 men and 61 women were HIV seropositive without TB disease, whereas 160 men and 256 women were HIV seronegative without TB disease (Table 1). In Table 1, among 420 men and 524 women regardless of HIV status, there were no significant differences in average age between participants with and participants without TB

Discussion

In this study of 944 Ugandan adults, the poor nutritional status associated with TB disease differed among men and women, yet was not affected by HIV serostatus. The average weight difference in men with TB disease consisting of body cell mass and fat mass in equal proportion, whereas for women, the average weight difference was predominantly fat mass. This pattern of average weight difference did not differ by HIV serostatus regardless of gender.

Our findings suggest that TB disease, not HIV

References (40)

S.A. Rubin
Tuberculosis. Captain of all these men of death
Radiol Clin North Am
(1995)
N.I. Paton et al.
Effects of tuberculosis and HIV infection on whole-body protein metabolism during feeding, measured by the [15N]glycine method
Am J Clin Nutr
(2003)
R. Zachariah et al.
Moderate to severe malnutrition in patients with tuberculosis is a risk factor associated with early death
Trans R Soc Trop Med Hyg
(2002)
S. Shah et al.
Severity of human immunodeficiency virus infection is associated with decreased phase angle, fat mass and body cell mass in adults with pulmonary tuberculosis infection in Uganda
J Nutr
(2001)
N. Kennedy et al.
Nutritional status and weight gain in patients with pulmonary tuberculosis in Tanzania
Trans R Soc Trop Med Hyg
(1996)
T. Niyongabo et al.
Tuberculosis, human immunodeficiency virus infection, and malnutrition in Burundi
Nutrition
(1999)
U.G. Kyle et al.
Bioelectrical impedance analysis–part II: Utilization in clinical practice
Clin Nutr
(2004)
D.P. Kotler et al.
Prediction of body cell mass, fat-free mass, and total body water with bioelectrical impedance analysis: effects of race, sex, and disease
Am J Clin Nutr
(1996)
S.S. Sun et al.
Development of bioelectrical impedance analysis prediction equations for body composition with the use of a multicomponent model for use in epidemiologic surveys
Am J Clin Nutr
(2003)
R. Roubenoff
Applications of bioelectrical impedance analysis for body composition to epidemiologic studies
Am J Clin Nutr
(1996)

D.C. Macallan et al.

Prospective analysis of patterns of weight change in stage IV human immunodeficiency virus infection

Am J Clin Nutr

(1993)

N.I. Paton et al.

Body composition studies in patients with wasting associated with tuberculosis

Nutrition

(2006)

B. Swanson et al.

Body composition in HIV-infected women

Nutrition

(2000)

D.P. Kotler et al.

Magnitude of body-cell-mass depletion and the timing of death from wasting in AIDS

Am J Clin Nutr

(1989)

J.E. Morley et al.

Cachexia: pathophysiology and clinical relevance

Am J Clin Nutr

(2006)

D.R. Thomas

Distinguishing starvation from cachexia

Clin Geriatr Med

(2002)

S.S. Yeh et al.

The cytokine basis of cachexia and its treatment: are they ready for prime time?

J Am Med Dir Assoc

(2008)

A. Schwenk et al.

Tuberculosis, malnutrition and wasting

Curr Opin Clin Nutr Metab Care

(2000)

Global Tuberculosis Control: Surveillance, Planning, Financing

(2004)

M. van Lettow et al.

Triple trouble: the role of malnutrition in tuberculosis and human immunodeficiency virus co-infection

Nutr Rev

(2003)

Cited by (24)

Assessment of body composition during pulmonary tuberculosis
2021, Revue des Maladies Respiratoires
Bien que l’indice de masse corporelle (IMC) soit l’outil le plus souvent utilisé pour évaluer l’état nutritionnel des patients atteints de tuberculose (TB) active, il n’évalue pas les modifications de la composition corporelle de ces patients. Le but de ce travail était ainsi d’évaluer le statut nutritionnel des patients atteints de TB par une impédancemétrie bioélectrique (BIA), comparativement à l’IMC, et de rechercher les facteurs associés à la dénutrition.
Étude transversale menée dans le service de pneumologie du CHU la Rabta à Tunis (Tunisie) chez des patients atteints de TB active. L’évaluation nutritionnelle s’est basée sur la mesure de l’IMC et l’analyse de la composition corporelle par BIA. Une dénutrition était retenue quand l’indice de masse maigre (IMM) était ≤ 16 kg/m² chez l’homme et 15 kg/m² chez la femme.
Quatre-vingt-quinze patients ont été inclus. Selon l’IMM, 38 patients (40 %) étaient dénutris. La baisse de l’IMM était associée à la gravité de la TB. Bien que l’IMC et l’IMM soient corrélés, l’utilisation de l’IMC seul faisait méconnaître la perte en masse maigre chez un patient sur dix.
La dénutrition est fréquente chez les patients tuberculeux. Elle est associée à la gravité de la maladie. Outre le traitement antituberculeux, une prise en charge nutritionnelle des patients serait indispensable.
Although the body mass index (BMI) is the most commonly used tool to assess the nutritional status of patients with active tuberculosis (TB), it does not assess changes in body composition. This study aims to assess the contribution of bioelectrical impedancemetry (BIA) for the assessment of body composition during the course of TB compared to BMI and to examine the associated factors.
Cross-sectional study carried out in patients with active TB at the pulmonology department of CHU la Rabta in Tunis, Tunisia. The nutritional assessment was based on the measurement of BMI and the analysis of body composition by BIA. Malnutrition was accepted when the lean mass index (LMI) was ≤ 16 kg/m² in men and 15 kg/m² in women.
Ninety-five patients were included. According to their LMI, 38 patients were undernourished. The decline in LMI was associated with the severity of TB. Although BMI and LMI were correlated, the use of BMI alone failed to recognize lean mass loss in one in ten patients.
Undernutrition is frequent in patients with active TB. It is correlated with the severity of the disease. In addition to anti-tuberculosis drugs, nutritional management of these patients is essential.
Lean Tissue Mass Wasting is Associated With Increased Risk of Mortality Among Women With Pulmonary Tuberculosis in Urban Uganda
2012, Annals of Epidemiology
Citation Excerpt :
BIA measurements were performed in triplicate for each subject and the average was used. Lean tissue mass was calculated from BIA measurements using equations that were previously cross-validated in a sample of patients with and without HIV infection (18) and have been applied elsewhere in African studies (19–21). Fat mass was calculated as body weight minus fat-free mass.
We assessed the impact of wasting on survival in patients with tuberculosis by using a precise height-normalized lean tissue mass index (LMI) estimated by bioelectrical impedance analysis and body mass index (BMI).
In a retrospective cohort study, 747 adult pulmonary patients with tuberculosis who were screened for HIV and nutritional status were followed for survival.
Of 747 patients, 310 had baseline wasting by BMI (kg/m²) and 103 by LMI (kg/m²). Total deaths were 105. Among men with reduced BMI, risk of death was 70% greater (hazard ratio [HR] 1.7, 95% confidence interval [95% CI] 1.03–2.81) than in men with normal BMI. Survival did not differ by LMI among men (HR 1.1; 95% CI 0.5–2.9). In women, both the BMI and LMI were associated with survival. Among women with reduced BMI, risk of death was 80% greater (HR 1.8; 95% CI 0.9–3.5) than in women with normal BMI; risk of death was 5-fold greater (HR 5.0; 95% CI 1.6–15.9) for women with low LMI compared with women with normal LMI.
Wasting assessed by reduced BMI is associated with an increased risk for death among both men and women whereas reduced LMI is among women with tuberculosis.
Effects of underweight and overweight on mortality in patients with pulmonary tuberculosis
2023, Frontiers in Public Health
Assessment of Body Mass Index of Tuberculosis Patients on Anti-Tuberculosis Drugs in Ibadan, Oyo State, Nigeria
2022, Nigerian Journal of Nutritional Sciences
Malnutrition assessment methods in adult patients with tuberculosis: A systematic review
2021, BMJ Open
Estimation of Heights and Body Masses of Tuberculosis Patients in the Canadian Fluoroscopy Cohort Study for Use in Individual Dosimetry
2021, Health Physics

View all citing articles on Scopus

View full text

Body Composition Among HIV-Seropositive and HIV-Seronegative Adult Patients with Pulmonary Tuberculosis in Uganda

Purpose

Methods

Results

Conclusions

Introduction

Section snippets

Material and Methods

Results

Discussion

Radiol Clin North Am

Am J Clin Nutr

Trans R Soc Trop Med Hyg

J Nutr

Trans R Soc Trop Med Hyg

Nutrition

Clin Nutr

Am J Clin Nutr

Am J Clin Nutr

Am J Clin Nutr

Am J Clin Nutr

Nutrition

Nutrition

Am J Clin Nutr

Am J Clin Nutr

Clin Geriatr Med

J Am Med Dir Assoc

Tuberculosis, malnutrition and wasting

Curr Opin Clin Nutr Metab Care

Global Tuberculosis Control: Surveillance, Planning, Financing

Triple trouble: the role of malnutrition in tuberculosis and human immunodeficiency virus co-infection

Nutr Rev